Involving family, community members could improve population-level blood pressure

Key takeaways:

• Involving family members and community leaders in blood pressure monitoring and lifestyle education may improve population-level blood pressure.
• Further research is needed in populations outside of China.

NEW ORLEANS — A family- and community-centered approach to managing population-level blood pressure in China was successful and resulted in more antihypertensive medication use and reductions in hypertension prevalence, a speaker reported.

An intervention involving family and community leaders that improved BP could subsequently decrease cardiovascular event rates, if the results are applicable outside of a Chinese population.

The results of the multicenter, open-label, cluster-randomized controlled Healthy Family trial were presented at the American Heart Association Scientific Sessions.

“Hypertension is the leading modifiable cause of premature death and disability worldwide. In China, hypertension control rates are very low, at just 13%. A major limitation of conventional strategy to manage hypertension is that we just focus on the individual-level intervention within a clinical setting,” Jun Cai, MD, PhD, professor at Beijing Anzhen Hospital at the Capital Medical University in Beijing, said during a press conference. “The complementary strategy to lower the blood pressure in the entire population is critically needed, as a modest reduction in average systolic blood pressure may provide a significant reduction in cardiovascular events at the population level.”

Eighty village clusters in Ruyang County, Henan province, China, including approximately 8,000 individuals, were included in the study and assigned to the intervention arm or usual care.

The intervention arm involved designation of a family leader within each family who was responsible for measuring BP and uploading their family’s readings to the WeChat platform, participating in lifestyle education classes and encouraging family to seek medical care if systolic BP was 140 mm Hg or more. A village leader was designated to assist family leaders in their responsibilities and to coordinate the educational sessions and group exercises. Village doctors were also designated to prescribe BP medication and consult with specialists if BP remained uncontrolled.

The intervention continued for 6 months, and the primary outcome was change in systolic BP. Secondary outcomes included change in diastolic BP, proportion with BP of less than 130/80 mm Hg and proportion of antihypertensive therapy at 6 months, and change in systolic BP at 12 months. Safety outcomes included CV events, all-cause mortality, serious adverse events and adverse events of special interest such as hypotension, syncope, hyponatremia, hyperkalemia, injurious falls and acute kidney injury.

The average age was approximately 61 years, with more than half being women and the majority having attained a secondary school education or less. The mean systolic BP was 133 mm Hg in the intervention arm and 130 mm Hg in the control arm.

At 6 months, systolic BP was reduced on average by 6.1 mm Hg in the intervention arm and increased 5.1 mm Hg in the control group, for an adjusted mean difference of 10.7 mm Hg (95% CI, 11.8 to 9.6), according to the presentation.

Cai said prior data have shown that for every 5 mm Hg decrease in BP, there is a 10% decrease in CV events.

From 6 to 12 months after withdrawal of the intervention, the adjusted mean difference decreased to 3.7 mm Hg, but remained statistically significant (95% CI, 4.9 to 2.6).

In the Healthy Family intervention arm vs. the usual care control arm, the researchers also reported:

• an adjusted mean difference in diastolic BP of 3.2 mm Hg;
• increased odds of participants taking antihypertensive medications (OR = 1.6; 95% CI, 1.1-2.3); and
• increased likelihood of BP less than 130/80 mm Hg at 6 months (intervention, 46.2%; control, 23.6%; OR = 5.3; 95% CI, 4.3-6.6).

The rate of serious adverse events was low and comparable between the intervention and control groups (2.8% for intervention vs. 2.3% for control), whereas CV events occurred in 0.6% of the intervention group and 0.5% of the control group at 6 months.

The researchers noted the intervention had a significantly stronger effect among older adults, those with a history of hypertension or BP of 140/90 mm Hg or more at baseline.

“By involving local community members, this study was found affordable and a simple way to help everyone lower their blood pressure overall,” Cai said during the presentation. “The result of this study could have important benefits. Since the study was done in China, this result may not apply to other areas. Also, the study wasn’t designed to measure how much the intervention reduced cardiovascular events directly. … Follow-up research is needed to confirm if it can reduce heart disease and stroke.”

After the presentation, Keith C. Ferdinand, MD, FAHA, FACC, FASPC, FNLA, FPCNA (hon), Gerald S. Berenson Endowed Chair in Preventive Cardiology, professor of medicine in the John W. Deming Department of Medicine at Tulane University School of Medicine and a member of the Healio | Cardiology Today Editorial Board, said: “The question is, can it be applied to other geographic areas?

“Here in New Orleans, my home, we have a large publicly funded grant, in which we go into churches and use the same randomized cluster approach to eliminate disparities. Over 850 African Americans have already been enrolled in 42 churches. We address diabetes, high cholesterol, hypertension and we use implementation strategies very similar to what Cai has done,” Ferdinand said. “The outcome is going to be on implementation strategies and a decrease in PREVENT risk calculation. We don’t have results, but hopefully what was done successfully in China can be now used in the United States.”

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